Basic Information
| Provider Information | |||||||||
| NPI: | 1174851414 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ANTO VINCETIC DPM PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21455 JAMAICA AVE | ||||||||
| Address2: | |||||||||
| City: | QUEENS VILLAGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114281733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183470494 | ||||||||
| FaxNumber: | 7183476793 | ||||||||
| Practice Location | |||||||||
| Address1: | 3626 E TREMONT AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104652030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184090400 | ||||||||
| FaxNumber: | 7185978962 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2009 | ||||||||
| LastUpdateDate: | 06/21/2010 | ||||||||
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| AuthorizedOfficialLastName: | VINCETIC | ||||||||
| AuthorizedOfficialFirstName: | ANTO | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 7183470494 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.P.M | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 005796 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.